保存的治療で寛解したステージ３の薬剤関連顎骨壊死の１例

• Published in: 日本口腔外科学会雑誌 Vol. 71; no. 7; pp. 311 - 315
• Main Authors: 大前 尭之, 服部 洋一, 岸本 裕充, 髙岡 一樹, 野口 一馬, 柿本 知毅
• Format: Journal Article
• Language: Japanese
• Published: 公益社団法人 日本口腔外科学会 20.07.2025
• Subjects: テリパラチド; 保存的治療; 区域切除; 薬剤関連顎骨壊死; 骨粗鬆症
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.71.311

We report a case of stage 3 medication-related osteonecrosis of the jaw (MRONJ) in remission with conservative therapy. A 79-year-old woman visited her dentist with the complaint of pain in the left mandibular molar. She had a history of osteoporosis and had been on teriparatide therapy for two years followed by bisphosphonates (BP) for a year. She was referred to a certain university hospital. A buccal fistula was observed and she was diagnosed with MRONJ stage 2. The BP were withdrawn and CLDM was administered, however the extraoral fistula on the submental region and the intraoral fistula on the right torus mandibularis developed, and she was diagnosed as having progressed to stage 3. Her doctors proposed a segmental resection of the mandible, however she refused surgery, and visited our department. 　On initial examination, spontaneous pain had improved and the extraoral fistula had closed with continued CLDM. We extracted the mandibular left second premolar, first molar and second molar, and a biopsy around the extraction socket showed osteonecrosis. Since epithelialization of the sockets was observed, the necrosis was considered localized and the condition was thought to be primarily osteomyelitis. After changing her antibiotics to AMPC and CVA/AMPC, and the administration of hyperbaric oxygen therapy, the intraoral fistula disappeared and she entered remission.